MEDICARE: QIAN YANG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3448-35	WI

General Provider Information

NPI Number	:	1891236089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIAN YANG O.D.

Provider Business Mailing Address
First Line	:	323 CEDAR AVE
Second Line	:
City	:	WEST BERLIN
State	:	NJ
Zip	:	08091-9168
Country	:	US
Telephone Number	:	609-598-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 S PACKARD AVE
Second Line	:
City	:	CUDAHY
State	:	WI
Zip	:	53110-3028
Country	:	US
Telephone Number	:	414-769-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	11/10/2017

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Directions to “ QIAN YANG O.D.” Practice Location

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